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Immediate Breast Reconstructions in Breast Cancer Patients

100%

Hyza P., Vesely J., Dražan L., Coufal O., Choudry U.

Polish Journal of Surgery

2008

vol. 80

issue 10

531-539

In mastectomy women an immediate breast reconstruction has become a real option over the past several years. Like many other reconstructive procedures, breast reconstruction aims not only to restore body form and anatomy, but also to improve quality of life and emotional well-being.The aim of the study was to review the cases of mastectomies and immediate breast reconstructions within 8 years and propose a mastectomy-reconstructive protocol to be used and evaluated for the future.Material and methods. Since January 2001, 39 patients of average age 43.9 years underwent mastectomy for early breast cancer and subsequent immediate reconstruction. Patients had either the breast reconstructed with an abdominal flap at the time of mastectomy, or they had a two stage reconstruction with the expander placed during mastectomy procedure and subsequent silicone-gel implant placement. The retrospective chart review of the records of patients with diagnosis of breast cancer were reviewed for histology, tumor size and technique of reconstruction used. Based on the pictures of postoperative results and the chart review, the reconstructive protocol was proposed.Results. The number of patients having immediate reconstruction has significantly increased over the past three years compare to previous period form 2001 till 2005. Majority of the patients were treated for early breast cancers (DCIS - ductal carcinoma in situ or invasive cancer smaller than 2 cm). The vital tissue was used for the reconstruction in 27 patients(71%). Silicone gel implant/implants were used for reconstruction in 11(29%) patients. 23 reconstructions was bilateral for the diagnosis of high oncological risk of contralateral breast parenchyma. Best results were achieved in patients with bilateral breast reconstructions having skin sparing or nipple sparing mastectomy and not having postmastectomy radiation therapy.Conclusions. The immediate breast reconstruction seems to be a reasonable solution for many patients having mastectomy for early breast cancer, smaller than 2 cm and negative sentinel node biopsy (low risk for postmastectomy radiation therapy). We prefer skin sparing or nipple sparing mastectomy if possible. The reconstruction with abdominal tissue results in a good and time-stable results in majority of the cases.

Assessment of postural disorders in women after radical mastectomy followed by immediate breast reconstruction

86%

Bąk M., Cieśla S.

2009

vol. 17

issue 1

30-37

Leczenie chirurgiczne raka piersi zmierza do minimalizacji urazu operacyjnego przy zachowaniu pełnej skutecz-ności onkologicznej. Pomimo to w wyniku leczenia dochodzi do zaburzeń w postawie ciała. W przypadkach kiedy niezbędna jest radykalna mastektomia, w Polsce coraz częściej stosuje się amputację z jednoczasową rekonstrukcją ekspandero-protezą Becker. Celem pracy jest ocena zaburzeń postawy ciała kobiet po mastektomii z jednoczasową rekonstrukcją piersi protezą Becker-25 oraz porównanie z postawą kobiet po mastektomii. Badaniami objęto 80 kobiet po mastektomii - u 40 kobiet wykonano amputację radykalną piersi z rekonstrukcją piersi, a u 40 amputację radykalną z jednoczasową rekonstrukcją piersi ekspandero-protezą Becker-25. Grupę kontrolną stano-wiło 40 kobiet nie leczonych z powodu raka piersi. Postawę ciała oceniano przy użyciu aparatury do komputerowej fotogrametrycznej oceny postawy. U kobiet po mastektomii badania te przeprowadzono sześć miesięcy po ope-racji. Zanotowano większe zaburzenia postawy ciała w płaszczyźnie czołowej kobiet po mastektomii w porówna-niu z kobietami po jednoczasowej rekonstrukcją piersi. Zmiany te dotyczyły położenia łopatek, barków, miednicy, różnicy szerokości trójkątów talii, nachylenia tułowia i odchylenia linii wyrostków kolczystych od pionu. Różnice te (poza wysokością trójkątów talii) okazały się statystycznie istotne. Kobiety po mastektomii bardziej pochylały się do przodu. Nie stwierdzono statystycznie istotnej różnicy wartości analizowanych zmiennych pomiędzy kobietami po rekonstrukcji a kobietami zdrowymi. Jedynie wartości kąte nachylenia miednicy stanowiły statystycznie istotną różnicę. Uzyskane wyniki badań pozwalają stwierdzić, że zastosowana jednoczasowa rekonstrukcja po amputacji piersi pozwala zmniejszyć niekorzystne zmiany postawy ciała kobiet leczonych z powodu raka piersi.

Surgical treatment of breast cancer aims at minimizing of post-operative trauma, while maintaining full oncological effectiveness at the same time. Despite that, women operated due to breast cancer often suffer from postural disorders. In Poland, in the cases, when radical mastectomy is required, the operation is often followed by immediate breast reconstruction using Becker permanent expander prosthesis.The aims of this study are the assessment of postural disorders in women after mastectomy and immediate breast reconstruction using Becker-25 prosthesis and comparison of the research group with other women after mastectomy. The research was conducted on 80 women - 40 women were subjected to radical mastectomy and breast reconstruction and the other 40 women underwent radical mastectomy and immediate breast reconstruction using Becker-25 prosthesis. The control group consisted of 40 women, who had not been treated due to breast cancer. Posture was assessed by means of computerized photogrammetry. In women after mastectomy, posture was evaluated 6 months after the surgery. Larger postural disorders in the frontal plane were observed in women who had been subjected to mastectomy and breast reconstruction. Those changes concerned the placement of shoulder blades, shoulders, pelvis, waist triangles height, trunk inclination and deviation of the spinous process line from the vertical axis of the body. Those differences (apart from the waist triangles height) turned out to be statistically significant. Women after mastectomy tended more to lean forward in comparison to women with Becker-25 prosthesis. There were no significant differences of the analysed parameters between women after breast reconstruction and the healthy women, apart from the pelvis inclination angle. Findings allow one to state that the applied immediate breast reconstruction helps reduce the negative postural changes in women operated for breast cancer.

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1 Physiotherapy

1 Polish Journal of Surgery

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1 Bąk M.

1 Choudry U.

1 Cieśla S.

1 Coufal O.

1 Dražan L.

1 Hyza P.

1 Vesely J.

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Immediate Breast Reconstructions in Breast Cancer Patients

Assessment of postural disorders in women after radical mastectomy followed by immediate breast reconstruction